Nokea
An older adult takes digoxin and hydrochlorothiazide daily, as well as lorazepam as needed for anxiety. Over 2 days, this adult developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of which adverse reaction to the medication therapy?
- A. Delirium
- B. Dementia
- C. Amnestic syndrome
- D. Alzheimer's disease
Correct Answer: A
Rationale: Delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded consciousness, perceptual disturbances, and disturbed memory and orientation. The onset of dementia or Alzheimer's disease, a type of dementia, is more insidious. Amnestic syndrome involves memory impairment without other cognitive problems.
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Goals and desired outcomes for an older adult patient experiencing delirium caused by fever and dehydration will focus on what?
- A. Returning to premorbid levels of function
- B. Identifying stressors negatively affecting self
- C. Demonstrating motor responses to noxious stimuli
- D. Exerting control over responses to perceptual distortions
Correct Answer: A
Rationale: The desired overall goal is that the patient with delirium will return to the level of functioning held before the development of delirium since the condition is usually temporary in nature. Demonstrating motor responses to noxious stimuli is an appropriate indicator for a patient whose arousal is compromised. Identifying stressors that negatively affect the self is too nonspecific to be useful for a patient experiencing delirium. Exerting control over responses to perceptual distortions is an unrealistic indicator for the patient with sensorium problems related to delirium.
An older adult drove to a nearby store but was unable to remember how to get home or state an address. When police took the person home, the spouse reported frequent wandering into neighbors' homes. Which stage of Alzheimer's disease is evident?
- A. 1 (mild)
- B. 2 (moderate)
- C. 3 (moderate to severe)
- D. 4 (late)
Correct Answer: B
Rationale: In stage 2 (moderate), deterioration is evident. Memory loss may include the inability to remember addresses or the date. Activities such as driving may become hazardous, and frustration by the increasing difficulty of performing ordinary tasks may be experienced. Hygiene may begin to deteriorate. Stage 3 (moderate to severe) finds the individual unable to identify familiar objects or people and needing direction for the simplest of tasks. In stage 4 (late), the ability to talk and walk is eventually lost, and stupor evolves.
Which description of patient behavior best applies to a hallucination?
- A. Looking at shadows on a wall and says, 'I see scary faces'
- B. Stating, 'I feel bugs crawling on my legs and biting me'
- C. Becoming anxious when the nurse leaves his or her bedside
- D. Trying to hit the nurse when vital signs are taken
Correct Answer: B
Rationale: A hallucination is a false sensory perception occurring without a corresponding sensory stimulus. Feeling bugs on the body when none are present is a tactile hallucination. Misinterpreting shadows as faces is an illusion. An illusion is a misinterpreted sensory perception. The incorrect options are examples of behaviors that sometimes occur during delirium and are related to fluctuating levels of awareness and misinterpreted stimuli.
A nurse should anticipate that which symptoms of Alzheimer's disease will become apparent as the disease progresses from stage 3, moderate to severe to stage 4, late stage?
- A. Agraphia
- B. Hyperorality
- C. Fine motor tremors
- D. Hypermetamorphosis
- E. Improvement of memory
Correct Answer: A,B,D
Rationale: The memories of patients with Alzheimer's disease continue to deteriorate. These patients demonstrate the inability to read or write (agraphia), the need to put everything into the mouth (hyperorality), and the need to touch everything (hypermetamorphosis). Fine motor tremors are associated with alcohol withdrawal delirium, not dementia. Memory does not improve.
Consider these health problems: Lewy body disease, Pick disease, and Parkinson's disease. Which term unifies these problems?
- A. Intoxication
- B. Dementia
- C. Delirium
- D. Amnesia
Correct Answer: B
Rationale: The listed health problems are all forms of dementia.